Nonmedical Options for Treating LPRD

There are many lifestyle changes that you can make to control or prevent GERD/LPRD. I call this my gastroesophageal (GE) Reflux Recommendations.

GE REFLUX RECOMMENDATIONS

Do not smoke, and if you do quit immediately. Among the many dangers of smoking
is that it will cause and exacerbate reflux disease by irritating the membranes of the stomach, esophagus, nose, and sinuses.

Try to maintain a healthy body weight. Being overweight can dramatically increase reflux. Being overweight causes a shift in the position of the GE junction. For patients with recent weight gain, shedding a few pounds is often all that is required to control reflux. You don’t have to lose 50 pounds in 1 week. Instead, try to lose Vi pound per week until you lose the desired amount of weight. This is a very realistic goal and can be accomplished by modifying your diet, developing good eating habits, staying well hydrated, and exercising. I tell my patients to eat three to four small meals daily, instead of fewer, larger meals. Don’t skip meals, especially breakfast.

Pay close attention to how your system reacts to various foods.

We each have distinct foods that cause an increase in our reflux. The foods that are most often reactive are caffeine, cola beverages, acidic fruits and their juices (orange or tomato juice), mints, spicy foods, acidic and tomato-based foods (Mexican or Italian) alcoholic beverages (particularly at night), cheese, fried foods, eggs, and chocolate. Carbohydrates, including breads, pasta, and rice, are also thought to cause reflux. By avoiding these foods entirely, you may see a significant change in your reflux. You can then add them back into your diet, one food group at a time for 1 week to see what the culprit is.

Stay away from tight belts and restrictive clothing. Weight loss will also help you avoid tight-fitting clothes that exacerbate reflux problems. Tight-fitting clothes will also shift the position of your GE junction.

Avoid bedtime snacks. Your last meal should be finished no less than 3 hours before bedtime. Food left in your stomach before you go to sleep will reflux into your esophagus. If you give yourself time to properly digest your food before you go to sleep, the food has time to pass from the stomach down to the intestines where it will no longer reflux into the esophagus after you lie down. Therefore, if you feel like having dessert, eat your ice cream right after dinner, not as you are sliding into bed. In fact, avoiding eating a large meal at night will help greatly. Your body will be better able to digest food throughout the day.

Drink water all day long. You need to stay well hydrated. This will keep the material in your stomach moving. It will keep your membranes moist, and replenish the water in all of the cells of your body, keeping them healthy.

Make time in your schedule to do activities that lower your stress level. Avoid stress and take significant steps to reduce stress. Even moderate stress can dramatically increase the amount of reflux. It also increases the amount of acids released in your stomach. Decreasing stress will reduce reflux. Try meditation, yoga, or light exercise every day. However, do not exercise immediately after eating because this can shift the position of the GE junction.

Elevate the head of your bed 4-6 inches. This will allow gravity to help decrease reflux that may occur when you are lying flat on your back. You can use sites, bricks, or a block of wood under the legs of the head of your bed to achieve a 10- to 15-degree slant. Do not prop up your head and neck with extra pillows. This may increase reflux by kinking the stomach. Recent studies have shown that reflux occurs much more often during the day when upright; therefore, raising your bed may be much less important than once believed.

Gargle with a glass of salt water twice a day before you brush your teeth. You should use Va teaspoon of salt in an 8-ounce glass of water. This will soothe the irritation and wash the stomach acid from the membranes.

By following these recommendations, you may be able to skip GERD/ LPRD medications entirely.

Lauren, a 58-year-old executive, came to see me because of her chronic coughing. She worked late hours and had to frequently wine and dine her clients. She usually felt fine, but when one of her coughing bouts began, it could go on for days. Lauren told me that she felt as if something were caught in her throat, but nothing she did could alleviate the feeling, even at night. The feeling once was so severe that she was rushed to the hospital; but by the time she got there, the episode had passed.

It is interesting that Lauren did not suffer from sinus problems, heartburn, or indigestion, and she didn’t think that she had reflux. She didn’t burp, and she was not overweight. She occasionally had late-night snacks before going to bed, and admitted to me that her eating habits were not good. Her breakfast consisted of two quick cups of coffee. She occasionally ate lunch but usually skipped the meal because she knew she would be eating a large dinner out with clients. Dinner was usually accompanied by a few social drinks. During the day, she drank a lot of coffee and soda to keep alert, and she did not feel hungry.

Lauren was seen by her internist and various consultants for her coughing. They all agreed that Lauren was not suffering from sinus problems, and placed her on GERD medications, although nothing relieved her cough. She was diagnosed with panic attacks and had been seeing a psychiatrist who placed her on various medicines, also without results. She was then referred to my office.

Using a fiber-optic nasopharyngolaryngoscope, I was able to make the diagnosis of silent GERD (LPRD). I suggested my GE Reflux Recommendations. Lauren stopped drinking alcohol at dinner, and replaced her caffeine fix with bottled water and lemonade. She started to eat a small breakfast, a medium-size lunch, and cut down on the size of her dinners. She eliminated carbohydrates from most of her meals, and made sure that her last meal was finished at least 3 hours before going to sleep. She now includes exercise as part of her daily routine, which keeps her stress levels down. Within a month Lauren came back and told me that she feels much better. Her coughing has not returned, and she finally has uninterrupted sleep. Best of all, she is no longer taking any medicines.